Health-Related Quality of Life in People Across the Spectrum of CKD

Anoushka Krishnan; Armando Teixeira-Pinto; Wai H Lim; Kirsten Howard; Jeremy R Chapman; Antoni Castells; Simon D Roger; Michael J Bourke; Petra Macaskill; Gabrielle Williams; Charmaine E Lok; Fritz Diekmann; Nicholas Cross; Shaundeep Sen; Richard D M Allen; Steven J Chadban; Carol A Pollock; Robin Turner; Allison Tong; Jean Y H Yang; Narelle Williams; Eric Au; Anh Kieu; Laura James; Anna Francis; Germaine Wong; Jonathan C Craig

doi:10.1016/j.ekir.2020.09.028

Health-Related Quality of Life in People Across the Spectrum of CKD

Kidney Int Rep. 2020 Oct 3;5(12):2264-2274. doi: 10.1016/j.ekir.2020.09.028. eCollection 2020 Dec.

Authors

Anoushka Krishnan^{1

2}, Armando Teixeira-Pinto¹, Wai H Lim², Kirsten Howard¹, Jeremy R Chapman³, Antoni Castells⁴, Simon D Roger⁵, Michael J Bourke⁶, Petra Macaskill¹, Gabrielle Williams¹, Charmaine E Lok⁷, Fritz Diekmann⁸, Nicholas Cross⁹, Shaundeep Sen^{1

10}, Richard D M Allen¹¹, Steven J Chadban¹¹, Carol A Pollock¹², Robin Turner^{1

13}, Allison Tong¹, Jean Y H Yang¹⁴, Narelle Williams¹, Eric Au¹, Anh Kieu¹, Laura James¹, Anna Francis¹, Germaine Wong^{1

3}, Jonathan C Craig¹⁵

Affiliations

¹ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
² Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
³ Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia.
⁴ Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain.
⁵ Department of Renal Medicine, Gosford Hospital, Gosford, Australia.
⁶ Department of Gastroenterology, Westmead Hospital, Westmead, Australia.
⁷ Department of Medicine, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
⁸ Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain.
⁹ Department of Nephrology and Kidney Transplantation, Christchurch Hospital and Otago University, Christchurch, New Zealand.
¹⁰ Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia.
¹¹ Department of Renal Medicine, Royal Prince Alfred Hospital, and Charles Perkins Centre, The University of Sydney, Sydney, Australia.
¹² Department of Medicine, Northern Clinical School, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
¹³ Biostatistics Unit, Dunedin School of Medicine, University of Otago, Christchurch, New Zealand.
¹⁴ School of Mathematics and Statistics, The University of Sydney, Sydney, Australia.
¹⁵ College of Medicine and Public Health, Flinders University, Adelaide, Australia.

Abstract

Introduction: People with chronic kidney disease (CKD) experience reduced quality of life (QoL) because of the high symptom and treatment burden. Limited data exist on the factors associated with overall and domain-specific QoL across all CKD stages.

Methods: Using data from a prospective, multinational study (Australia, New Zealand, Canada, and Spain) in 1696 participants with CKD, we measured overall and domain-specific QoL (pain, self-care, activity, mobility, anxiety/depression) using the EuroQoL, 5 dimension, 3 level. Multivariable linear regression and logistic modeling were used to determine factors associated with overall and domain-specific QoL.

Results: QoL for patients with CKD stages 3 to 5 (n = 787; mean, 0.81; SD, 0.20) was higher than in patients on dialysis (n = 415; mean, 0.76; SD, 0.24) but lower than in kidney transplant recipients (n = 494; mean, 0.84; SD, 0.21). Factors associated with reduced overall QoL (β [95% confidence intervals]) included being on dialysis (compared with CKD stages 3-5: -0.06 [-0.08 to -0.03]), female sex (-0.03 [-0.05 to -0.006]), lower educational attainment (- 0.04 [-0.06 to -0.02), lacking a partner (-0.04 [-0.06 to -0.02]), having diabetes (-0.05 [-0.07 to -0.02]), history of stroke (-0.09 [-0.13 to -0.05]), cardiovascular disease (-0.06 [-0.08 to -0.03]), and cancer (-0.03 [-0.06 to -0.009]). Pain (43%) and anxiety/depression (30%) were the most commonly affected domains, with dialysis patients reporting decrements in all 5 domains. Predictors for domain-specific QoL included being on dialysis, presence of comorbidities, lower education, female sex, and lack of a partner.

Conclusions: Being on dialysis, women with CKD, those with multiple comorbidities, lack of a partner, and lower educational attainment were associated with lower QoL across all stages of CKD.

Keywords: EuroQoL-5D3L; chronic kidney disease; domain-specific QoL; quality of life.